CAJ | 학술논문

目的：评价静脉溶栓联合尼可地尔的治疗方案是否能够提高急性 ST 段抬高型心肌梗死（STEMI）患者的治疗效果。方法入选就诊于保定市第一中心医院行溶栓治疗的急性 STEMI 患者，随机分为尼可地尔组和对照组，尼可地尔组在确诊后即刻口服尼可地尔20 mg，之后5 mg 每日3次口服，对照组常规进行溶栓治疗，观察两组住院期间的心肌损伤程度，ST 段回落，急性期心律失常的发生率，心功能状况，以及随访6个月的心功能状况及随访期内不良心血管事件的发生率。结果共入选121例患者，尼可地尔组64例，对照组57例，两组基线资料无明显差异。溶栓后4、12、24小时监测的肌钙蛋白 I（cTNI）水平显示，两组在组间、不同时点以及组间和不同时点的交互作用差异均有统计学意义（P ＜0．05或＜0．01），尼可地尔组 cTNI 水平明显低于对照组；溶栓后监测的患者心电图 ST 段回落情况显示，两组在组间、不同时点以及组间和不同时点的交互作用差异均有统计学意义（P ＜0．05或＜0．01），尼可地尔组 ST 段回落明显大于对照组；急性期 Curtis-Walker 评分≥3分的比例尼可地尔组明显低于对照组（P ＜0．05）；室壁运动积分指数尼可地尔组明显低于对照组（P ＜0．05）；两组患者的不良心血管事件差异无统计学意义（P ＞0．05）。结论静脉溶栓联合口服尼可地尔治疗可进一步提高急性 STEMI 患者的心肌灌注水平，减少心肌损伤，改善心脏功能，减少心律失常的发生。
목적：평개정맥용전연합니가지이적치료방안시부능구제고급성 ST 단태고형심기경사（STEMI）환자적치료효과。방법입선취진우보정시제일중심의원행용전치료적급성 STEMI 환자，수궤분위니가지이조화대조조，니가지이조재학진후즉각구복니가지이20 mg，지후5 mg 매일3차구복，대조조상규진행용전치료，관찰량조주원기간적심기손상정도，ST 단회락，급성기심률실상적발생솔，심공능상황，이급수방6개월적심공능상황급수방기내불양심혈관사건적발생솔。결과공입선121례환자，니가지이조64례，대조조57례，량조기선자료무명현차이。용전후4、12、24소시감측적기개단백 I（cTNI）수평현시，량조재조간、불동시점이급조간화불동시점적교호작용차이균유통계학의의（P ＜0．05혹＜0．01），니가지이조 cTNI 수평명현저우대조조；용전후감측적환자심전도 ST 단회락정황현시，량조재조간、불동시점이급조간화불동시점적교호작용차이균유통계학의의（P ＜0．05혹＜0．01），니가지이조 ST 단회락명현대우대조조；급성기 Curtis-Walker 평분≥3분적비례니가지이조명현저우대조조（P ＜0．05）；실벽운동적분지수니가지이조명현저우대조조（P ＜0．05）；량조환자적불양심혈관사건차이무통계학의의（P ＞0．05）。결론정맥용전연합구복니가지이치료가진일보제고급성 STEMI 환자적심기관주수평，감소심기손상，개선심장공능，감소심률실상적발생。
ABSTRACT:Objective To evaluate the myocardial protective effects of nicorandil on patients with ST segment elevation myocardial infarction(STEMI)receiving successful thrombolysis.Methods The STEMI patients receiving thrombolysis at the hospital were randomly divided into nicorandil group and control group.Patients in the nicorandil group received a loading dose of nicorandil 20 mg immediately after the diagnosis and a maintenance dose of nicorandil 5 mg three times a day.Patients in the control group received routine treatment.Then,the degree of myocardial injury,the ST-segment resolution,the incidence of cardiac arrhythmia and the heart function of the two groups were compared.Additionally,the major adverse cardiovascular events(MACE)and the heart function of two groups at six months after their discharge from the hospital were also observed.Results A total of 121 patients were enrolled in the study,including 64 cases in nicorandil group and 57 cases in control group.The general characteristics of the patients between two groups had no significant difference.After thrombolysis,the troponin I (cTNI)showed significant difference(P <0.05 or P <0.01).The cTNI level was markedly lower after thrombolysis in nicorandil group than in control group.The ST-segment resolution also showed significant difference between two groups(P <0.05 or P <0.01).The ST-segment resolution in nicorandil group was better after thrombolysis than that in control group.There were fewer patients with Curtis-Walker score no less than 3 in nicorandil group,which were prominently less than those in control group (P <0.05).The Wall Motion Score Index(WMSI)in nicorandil group was also remarkably less than that in control group (P <0.05).However,there was no significant difference in MACE events between two groups. Conclusion Thrombolysis combined with oral administration of nicorandil can increase the effects of myocardial reperfusion and reduce the myocardial injury,so as to improve the heart function and reduce cardiac arrhythmia of STEMI patients.